甘肃省新型农村合作医疗监管机制研究
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摘要
一直以来,农民的医疗保障问题制约着农村经济的发展。改革开放以后,原有的合作医疗体系解体后,农民看病完全需要自费,而我国农民本身经济水平较差,农民的看病难、看病贵、因病致贫、因病返贫问题更加突出,这也是我国城乡差距越来越大的主要原因。因此,保障农民的身心健康,对于促进农村经济发展、构建和谐社会具有非常重大的意义。
甘肃地处西部欠发达地区,经济发展水平低,农民人均收入水平远未达到全国农民人均收入水平,很多地区的农民连温饱问题都尚未解决,因此农民对医疗健康的要求更为迫切。甘肃省自2003年进行新型农村合作医疗试点工作以来,取得了非常突出的成绩,总体运行良好,很大程度上提高了农民的医疗健康水平,保障了农民的身心健康,加快了甘肃省经济发展的速度。但随着新型农村合作医疗的广泛开展,覆盖率和参合率越来越高,基金规模越来越大,但同时新农合的监管问题也日益突出,监管的压力与任务愈重,基金在筹集、储存和补偿时都存在风险,尤其是补偿报销环节,资金被挪用和套取的情况时有发生；定点医疗机构的供给风险增加,行为不规范问题日益突出。这些都严重影响了农民对新农合的满意度,从而影响了新农合的高效、持续运行。
基于当前形势,笔者从甘肃省新型农村合作医疗的监管现状出发,在对调研数据和访谈结果进行客观、科学分析的基础上,运用相关理论分析了甘肃省新农合监管的模式、监管存在的问题以及核心利益相关者可能存在和发生的风险,强调新农合监管的必要性,进而提出了甘肃省新农合完善监管的思路与对策,以期能为甘肃省新农合的发展提供些许建议。
For a long time, the medical security problems of farmers it restricts the development of rural economy. After reform and opening up, after the collapse of the original cooperative medical care system, and farmers a doctor need to pay out-of-pocket completely, and farmers in China itself economic level is poorer, difficulty and high cost of farmers'to see a doctor, because of sickness poor, Chinese problem become more prominent because of illness, which is the main reason for the gap between urban and rural areas in our country is more and more big. Therefore, safeguard farmers'physical and mental health, to promote rural economic development and building a harmonious society is of great significance.
Gansu province is located in the western underdeveloped region, low level of economic development, per capita income level of farmers is far from the national per capita income level of farmers, farmers in many parts of the even the food and clothing problem hasn't been solved yet, so the farmers demand for health care is more urgent. Gansu province since2003since the new type of rural cooperative medical care pilot work, achieved outstanding results, overall, to a great extent improve the health level of the farmers, guarantee the farmers' physical and mental health, increasing the speed of economic development in Gansu province. However, as the new type of rural cooperative medical care were extensively developed, and the coverage and service rate is higher and higher, the fund size is bigger and bigger, but at the same time, new farming and regulatory issues are also increasingly prominent, the regulation of the heavy pressure and task, fund raising, stored and compensation risk, especially the compensation expenses, funds were misused or taking the situation happen; Increased risk of the supply of the medical establishment that decide a dot, the behavior is not standard problem increasingly prominent. These have seriously affected the farmers to new farming and satisfaction, which affect the new farming and efficient, continuous operation.
Based on the current situation, the author embarks from the regulatory status quo of Gansu province new rural cooperative medical, in the survey data and the interview results are objective and scientific analysis, on the basis of using the related theory analysis of the agriculture of Gansu province new mode of regulation, regulatory problems and the potential and the risk of core stakeholders, emphasis on new farming and the necessity of regulation, new farmers in Gansu province were put forward. And the thinking and countermeasures of perfect regulation, for the development of new farmers in Gansu province and provide some Suggestions.
甘肃地处西部欠发达地区,经济发展水平低,农民人均收入水平远未达到全国农民人均收入水平,很多地区的农民连温饱问题都尚未解决,因此农民对医疗健康的要求更为迫切。甘肃省自2003年进行新型农村合作医疗试点工作以来,取得了非常突出的成绩,总体运行良好,很大程度上提高了农民的医疗健康水平,保障了农民的身心健康,加快了甘肃省经济发展的速度。但随着新型农村合作医疗的广泛开展,覆盖率和参合率越来越高,基金规模越来越大,但同时新农合的监管问题也日益突出,监管的压力与任务愈重,基金在筹集、储存和补偿时都存在风险,尤其是补偿报销环节,资金被挪用和套取的情况时有发生；定点医疗机构的供给风险增加,行为不规范问题日益突出。这些都严重影响了农民对新农合的满意度,从而影响了新农合的高效、持续运行。
基于当前形势,笔者从甘肃省新型农村合作医疗的监管现状出发,在对调研数据和访谈结果进行客观、科学分析的基础上,运用相关理论分析了甘肃省新农合监管的模式、监管存在的问题以及核心利益相关者可能存在和发生的风险,强调新农合监管的必要性,进而提出了甘肃省新农合完善监管的思路与对策,以期能为甘肃省新农合的发展提供些许建议。
For a long time, the medical security problems of farmers it restricts the development of rural economy. After reform and opening up, after the collapse of the original cooperative medical care system, and farmers a doctor need to pay out-of-pocket completely, and farmers in China itself economic level is poorer, difficulty and high cost of farmers'to see a doctor, because of sickness poor, Chinese problem become more prominent because of illness, which is the main reason for the gap between urban and rural areas in our country is more and more big. Therefore, safeguard farmers'physical and mental health, to promote rural economic development and building a harmonious society is of great significance.
Gansu province is located in the western underdeveloped region, low level of economic development, per capita income level of farmers is far from the national per capita income level of farmers, farmers in many parts of the even the food and clothing problem hasn't been solved yet, so the farmers demand for health care is more urgent. Gansu province since2003since the new type of rural cooperative medical care pilot work, achieved outstanding results, overall, to a great extent improve the health level of the farmers, guarantee the farmers' physical and mental health, increasing the speed of economic development in Gansu province. However, as the new type of rural cooperative medical care were extensively developed, and the coverage and service rate is higher and higher, the fund size is bigger and bigger, but at the same time, new farming and regulatory issues are also increasingly prominent, the regulation of the heavy pressure and task, fund raising, stored and compensation risk, especially the compensation expenses, funds were misused or taking the situation happen; Increased risk of the supply of the medical establishment that decide a dot, the behavior is not standard problem increasingly prominent. These have seriously affected the farmers to new farming and satisfaction, which affect the new farming and efficient, continuous operation.
Based on the current situation, the author embarks from the regulatory status quo of Gansu province new rural cooperative medical, in the survey data and the interview results are objective and scientific analysis, on the basis of using the related theory analysis of the agriculture of Gansu province new mode of regulation, regulatory problems and the potential and the risk of core stakeholders, emphasis on new farming and the necessity of regulation, new farmers in Gansu province were put forward. And the thinking and countermeasures of perfect regulation, for the development of new farmers in Gansu province and provide some Suggestions.
引文
[1]李和森.中国农村医疗保障制度的研究[M].北京：经济科学出版社.2005.
[1]陈吉绵.陕西省新型农村合作医疗监管问题研究[D].西安：西北大学,2010：7.
[2]王小林.结构转型中的农村公共服务与公共财政政策[M].北京：中国发展出版社,2008.
[1]蔡天新.新中国成立以来我国农村合作医疗制度的发展历程[J].党的文献.2009(3)：20-26.
[1]李立清.新型农村合作医疗制度[M].北京：人民出版社,2009.
[1]陈吉绵.陕西省新型农村合作医疗监管问题研究[D].西安：西北大学,2010：3.
[1]高选.欠发达地区新型农村合作医疗制度绩效研究[D].兰州：兰州大学,2010：30.
[1]朱玲.构建竞争性县乡医疗服务供给机制[J].管理世界,2006(6)；55-63.
[l]黄云鹏.公共服务监管研究：以中国教育、医疗为例[M],北京：中国金融出版社,2007.
[1]林闽钢.中国农村合作医疗制度的公共政策分析[J].江海学刊.2002,(3).
[l]毛正中,蒋家林.新型农村合作医疗制度的特征及目前面临的挑战[J].中国卫生经济.2005,(1)：41-45.
[1]郑涵.当代西方传媒制度[M].上海：上海交通大学出版社.2008.
[1] Cooperative Federation of Victoria Ltd(1997) opportunities for Co—operatives in Health Care[R], Discussion paper, No.3,April,1997
[2]邹文开.农村新型医疗保障政策研究[M].长沙：湖南人民出版社,2008.
[1]程晓明.医疗保险学[M].上海：复旦大学出版社,2003.
[2] Gunter B&wober, and M.The reactive viewer:A review of research on audience reaction measurement[M].London:John Libbery& company Ltd.1992
[1]高向华.论新型农村合作医疗的道德风险与对策[J].中国农村卫生事业管理.2007,27(5)：332-334.
[1] Gibbons, Robert.Game Theroy for Applied Economists[M].princeton University Press,1992.
[2]邓力群.当代中国卫生事业[M].北京：中国社会科学出版社,1987.
[1]王禄生,应亚珍.新型农村合作医疗基金运行风险防范对策[J].中国卫生经济.2006,25(11)：36-38.
[1]雷海潮,胡善连,李刚.CT检查中的过度使用研究[J].中国卫生经济.2002,(10)；23-26.
[2]张忠鲁.抗生素过度使用的成因与对策[J].医学与哲学.2005,(12)；19-32.
[1]王小林.结构转型中的农村公共服务与公共财政政策[M].北京：中国发展出版社.2008.
[1]寇日明.风险管理实务[M].北京：中国金融出版社.2000.
[1]毕天云.新型农村合作医疗制度中农民参与机制的基本框架-社会政策的视角[J].云南师范大学学报.2007,(1)：40-43.
[1]陈吉绵.陕西省新型农村合作医疗监管问题研究[D].西安：西北大学,2010：3.
[1]由建勋.化解新农合基金风险的对策研究[J].农业经济.2006,(3)：39-42.
[1]李金清.新农合政府监管机制研究[D].青岛：中国海洋大学,2010：38.
[1]李和森.中国农村医疗保障制度的研究[M].北京：经济科学出版社.2005.
[2]陈吉绵.陕西省新型农村合作医疗监管问题研究[D].西安：西北大学,2010：7.
[3]王小林.结构转型中的农村公共服务与公共财政政策[M].北京：中国发展出版社,2008.
[4]蔡天新.新中国成立以来我国农村合作医疗制度的发展历程[J].党的文献.2009(3)：20-26.
[5]李立清.新型农村合作医疗制度[M].北京：人民出版社,2009.
[6]高选.欠发达地区新型农村合作医疗制度绩效研究[D].兰州：兰州大学,2010：30.
[7]黄云鹏.公共服务监管研究：以中国教育、医疗为例[M],北京：中国金融出版社,2007.
[8]朱玲.构建竞争性县乡医疗服务供给机制[J].管理世界,2006(6)；55-63.
[9]闫茵.甘肃省新型农村合作医疗筹资与监管问题分析[D].兰州：兰州大学,2009：38.
[10]林闽钢.中国农村合作医疗制度的公共政策分析[J].江海学刊.2002,(3).
[11]毛正中,蒋家林.新型农村合作医疗制度的特征及目前面临的挑战[J].中国卫生经济.2005,(1)：41-45.
[12]郑涵.当代西方传媒制度[M].上海：上海交通大学出版社.2008.
[13]Cooperative Federation of Victoria Ltd(1997) opportunities for Co—operatives in Health Care[R], Discussion paper, No.3,April,1997
[14]邹文开.农村新型医疗保障政策研究[M].长沙：湖南人民出版社,2008.
[15]程晓明.医疗保险学[M].上海：复旦大学出版社,2003.
[16]Gunter B&wober, and M.The reactive viewer:A review of research on audience reaction measurement[M].London:John Libbery& company Ltd.1992
[17]高向华.论新型农村合作医疗的道德风险与对策[J].中国农村卫生事业管理.2007,27(5)：332-334.
[18]Gibbons, Robert.Game Theroy for Applied Economists[M].princeton University Press,1992.
[19]邓力群.当代中国卫生事业[M].北京：中国社会科学出版社,1987.
[20]王禄生,应亚珍.新型农村合作医疗基金运行风险防范对策[J].中国卫生经济.2006,25(11)：36-38.
[21]雷海潮,胡善连,李刚.CT检查中的过度使用研究[J].中国卫生经济.2002,(10)；23-26.
[22]张忠鲁.抗生素过度使用的成因与对策[J].医学与哲学.2005,(12)；19-32.
[23]王小林.结构转型中的农村公共服务与公共财政政策[M].北京：中国发展出版社.2008.
[24]寇日明.风险管理实务[M].北京：中国金融出版社.2000.
[25]毕天云.新型农村合作医疗制度中农民参与机制的基本框架-社会政策的视角[J].云南师范大学学报.2007,(1)：40-43.
[26]由建勋.化解新农合基金风险的对策研究[J].农业经济.2006,(3)：39-42.
[27]李金清.新农合政府监管机制研究[D].青岛：中国海洋大学,2010：38.
[1]陈吉绵.陕西省新型农村合作医疗监管问题研究[D].西安：西北大学,2010：7.
[2]王小林.结构转型中的农村公共服务与公共财政政策[M].北京：中国发展出版社,2008.
[1]蔡天新.新中国成立以来我国农村合作医疗制度的发展历程[J].党的文献.2009(3)：20-26.
[1]李立清.新型农村合作医疗制度[M].北京：人民出版社,2009.
[1]陈吉绵.陕西省新型农村合作医疗监管问题研究[D].西安：西北大学,2010：3.
[1]高选.欠发达地区新型农村合作医疗制度绩效研究[D].兰州：兰州大学,2010：30.
[1]朱玲.构建竞争性县乡医疗服务供给机制[J].管理世界,2006(6)；55-63.
[l]黄云鹏.公共服务监管研究：以中国教育、医疗为例[M],北京：中国金融出版社,2007.
[1]林闽钢.中国农村合作医疗制度的公共政策分析[J].江海学刊.2002,(3).
[l]毛正中,蒋家林.新型农村合作医疗制度的特征及目前面临的挑战[J].中国卫生经济.2005,(1)：41-45.
[1]郑涵.当代西方传媒制度[M].上海：上海交通大学出版社.2008.
[1] Cooperative Federation of Victoria Ltd(1997) opportunities for Co—operatives in Health Care[R], Discussion paper, No.3,April,1997
[2]邹文开.农村新型医疗保障政策研究[M].长沙：湖南人民出版社,2008.
[1]程晓明.医疗保险学[M].上海：复旦大学出版社,2003.
[2] Gunter B&wober, and M.The reactive viewer:A review of research on audience reaction measurement[M].London:John Libbery& company Ltd.1992
[1]高向华.论新型农村合作医疗的道德风险与对策[J].中国农村卫生事业管理.2007,27(5)：332-334.
[1] Gibbons, Robert.Game Theroy for Applied Economists[M].princeton University Press,1992.
[2]邓力群.当代中国卫生事业[M].北京：中国社会科学出版社,1987.
[1]王禄生,应亚珍.新型农村合作医疗基金运行风险防范对策[J].中国卫生经济.2006,25(11)：36-38.
[1]雷海潮,胡善连,李刚.CT检查中的过度使用研究[J].中国卫生经济.2002,(10)；23-26.
[2]张忠鲁.抗生素过度使用的成因与对策[J].医学与哲学.2005,(12)；19-32.
[1]王小林.结构转型中的农村公共服务与公共财政政策[M].北京：中国发展出版社.2008.
[1]寇日明.风险管理实务[M].北京：中国金融出版社.2000.
[1]毕天云.新型农村合作医疗制度中农民参与机制的基本框架-社会政策的视角[J].云南师范大学学报.2007,(1)：40-43.
[1]陈吉绵.陕西省新型农村合作医疗监管问题研究[D].西安：西北大学,2010：3.
[1]由建勋.化解新农合基金风险的对策研究[J].农业经济.2006,(3)：39-42.
[1]李金清.新农合政府监管机制研究[D].青岛：中国海洋大学,2010：38.
[1]李和森.中国农村医疗保障制度的研究[M].北京：经济科学出版社.2005.
[2]陈吉绵.陕西省新型农村合作医疗监管问题研究[D].西安：西北大学,2010：7.
[3]王小林.结构转型中的农村公共服务与公共财政政策[M].北京：中国发展出版社,2008.
[4]蔡天新.新中国成立以来我国农村合作医疗制度的发展历程[J].党的文献.2009(3)：20-26.
[5]李立清.新型农村合作医疗制度[M].北京：人民出版社,2009.
[6]高选.欠发达地区新型农村合作医疗制度绩效研究[D].兰州：兰州大学,2010：30.
[7]黄云鹏.公共服务监管研究：以中国教育、医疗为例[M],北京：中国金融出版社,2007.
[8]朱玲.构建竞争性县乡医疗服务供给机制[J].管理世界,2006(6)；55-63.
[9]闫茵.甘肃省新型农村合作医疗筹资与监管问题分析[D].兰州：兰州大学,2009：38.
[10]林闽钢.中国农村合作医疗制度的公共政策分析[J].江海学刊.2002,(3).
[11]毛正中,蒋家林.新型农村合作医疗制度的特征及目前面临的挑战[J].中国卫生经济.2005,(1)：41-45.
[12]郑涵.当代西方传媒制度[M].上海：上海交通大学出版社.2008.
[13]Cooperative Federation of Victoria Ltd(1997) opportunities for Co—operatives in Health Care[R], Discussion paper, No.3,April,1997
[14]邹文开.农村新型医疗保障政策研究[M].长沙：湖南人民出版社,2008.
[15]程晓明.医疗保险学[M].上海：复旦大学出版社,2003.
[16]Gunter B&wober, and M.The reactive viewer:A review of research on audience reaction measurement[M].London:John Libbery& company Ltd.1992
[17]高向华.论新型农村合作医疗的道德风险与对策[J].中国农村卫生事业管理.2007,27(5)：332-334.
[18]Gibbons, Robert.Game Theroy for Applied Economists[M].princeton University Press,1992.
[19]邓力群.当代中国卫生事业[M].北京：中国社会科学出版社,1987.
[20]王禄生,应亚珍.新型农村合作医疗基金运行风险防范对策[J].中国卫生经济.2006,25(11)：36-38.
[21]雷海潮,胡善连,李刚.CT检查中的过度使用研究[J].中国卫生经济.2002,(10)；23-26.
[22]张忠鲁.抗生素过度使用的成因与对策[J].医学与哲学.2005,(12)；19-32.
[23]王小林.结构转型中的农村公共服务与公共财政政策[M].北京：中国发展出版社.2008.
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